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DIT Nephrology > Ren 5 - Electrolyte Disorders > Flashcards

Ren 5 - Electrolyte Disorders Flashcards

1
Q

What is the substance that is the precursor for vitamin D3 when combined with UV rays in the skin?

A

It is 7-Dehydrocholesterol.

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2
Q

What is another name for Vitamin D3?

A

Cholecalciferol.

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3
Q

What enzyme converts Cholecalciferol into 25-Hydroxycholecalciferol and where is it located?

A

It is 25-hydroxylase. It is found in the liver.

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4
Q

Which enzyme converts 25-hydroxycholecalciferol into 1,25-dihydroxycholecalciferol?

A

1alpha-hydroxylase that resides in the kidney.

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5
Q

Which hormone influences the enzyme 1alpha-hydroxylase?

A

Parathyroid hormone (PTH).

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6
Q

What is another name for 1,25-Dihydroxycholecalciferol?

A

Calcitriol, or 1,25-DHCC.

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7
Q

What does PTH do in the kidneys?

A
  1. Influence the enzyme that is in 1alpha-hydroxylase. 2. Stimulates the kidneys to increase the reabsorption of calcium and decrease reabsorption of phosphate.
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8
Q

What are some hormones that influence the kidneys?

A
  1. PTH. 2. Renin-angiotensin-aldosterone. 3. Atrial natriuretic peptide (ANP). 4. Vasopressin.
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9
Q

How does Atrial natriuretic peptide (ANP) influences the kidneys?

A

When the atria has increased volume load and increased atrial pressure, it send a signal to the kidneys to constrict the efferent arterioles and dilate the afferent arterioles, increasing GFR and leading to diuresis.

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10
Q

What happens to the serum in patients with SIADH?

A

Too much ADH causes too much reabsorption of water and concentrating too much the urine. Low serum osmolality and low serum sodium.

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11
Q

What are the causes of SIADH?

A
  1. Ectopic ADH production: small cell lung cancer. 2. Pulmonary pathology. 3. Head trauma. 4. Stroke. 5. CNS infections. 6. Drugs, especially cyclophosphamide. 7. Idiopathic.
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12
Q

What happens in diabetes insipidus?

A
  1. Increase in urine volume. 2. Urine is very dilute. 3. Serum osmolarity is high. 4. Decrease in urine specific gravity.
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13
Q

What happens in Central diabetes insipidus?

A

There is deficient or absent production of ADH from the pituitary.

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14
Q

What happens in nephrogenic diabetes insipidus?

A

Kidneys are unresponsive to ADH.

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15
Q

How does lithium cause nephrogenic diabetes insipidus?

A

It interferes with aquaporin being deposited in the lumen side of the principal cells.

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16
Q

What are substances that can cause nephrogenic diabetes?

A
  1. Lithium. 2. Demeclocycline. 3. Hypercalcemia. 4. Hereditary mutation of ADH receptor.
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17
Q

How are urine and serum osmolarity in Diabetes insipidus?

A

Decrease in urine osmolarity. Increase in serum osmolarity.

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18
Q

What is a water deprivation test and what does it check for? What would be a normal test result?

A

It checks for diabetes insipidus. In normal patients it causes a rise in urine osmolarity. In patients with DI, it will decrease urine osmolarity because they lack ADH to concentrate their urine.

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19
Q

How can we check if a patient’s diabetes insipidus is central against nephrogenic?

A

Do the desmopressin challenge: Give patient desmopressin. If the patient has central DI, it increases urine osmolarity because it corrected the problem of small/absent ADH (desmopressin is an analogue of ADH). If it doesn’t, then it is nephrogenic, failing to change to urine osmolarity.

20
Q

What is the treatment for Central diabetes insipidus?

A

Intranasal desmopressin.

21
Q

What is the treatment for nephrogenic Diabetes insipidus?

A

Hydrochlorothiazide: we use this diuretic to make the patient a little dehydrated so that the proximal tubule can collect more water so by the time it gets to the collecting tubule, it is a little more concentrated. Indomethacin: can be used with Hydrochlorothiazides, it inhibits the prostaglandin synthesis, reducing renal blood flow, and decreasing urine output, somewhat.

22
Q

What is the treatment for lithium induced nephrogenic diabetes and how?

A

Amiloride blocks the sodium channels that lithium uses to enter the principal cell.

23
Q

What can hyponatremia cause?

A
  1. Altered mental status. 2. Seizures. 3. Stupor. 4. Coma.
24
Q

What does hypercalcemia cause?

A

[Stones, bones, abdominal groans, and psychiatric overtones]

-Confusion and delirium.

25
Q

What does hypocalcemia cause?

A

Tetany. Trousseau sign. Chvostek sign. (cheek sign).

26
Q

What does hypomagnesemia cause?

A

Tetany. EKG abnormalities: Wide QRS complex and Torsades de Pointes. Arrhythmia.

27
Q

What does hypermagnesemia cause?

A

Depress the reflexes.

28
Q

What does Hypokalemia cause?

A

Prolong the QT interval. V tach and Torsades. T waves: flattened. U waves.

29
Q

What does hyperkalemia cause?

A

V tach. T waves: tall and peaked.

30
Q

What happens to the T waves in hypokalemia versus hyperkalemia?

A

-T waves are tall and peaked in hyperkalemia. In HYPOkalemia, they are flattened.

31
Q

How is the potassium in the serum compared to potassium intracellularly?

A

Potassium in the serum is low compared to the potassium inside the cells.

32
Q

What kinds of things cause a shift of potassium out of the cells, causing hyperkalemia?

A

Low insulin. Beta-blockers. Acidosis. Digoxin. Cell lysis (i.e. Leukemia). Potassium-sparing diuretics. ACE inhibitors.

33
Q

What kinds of things cause a shift of potassium into the cells, causing hypokalemia?

A

Insulin. Beta agonists. Alkalosis. Cell creation/proliferation (cancer). Loop diuretics. Thiazides.

34
Q

What is a way to shift acutely potassium into the cell?

A

Beta agonsits like albuterol (nebulized). Alkalosis (IV bicarbonate). IV insulin (but give IV dextrose first).

35
Q

What electrolyte disturbance causes pontine myelinosis if corrected too rapidly?

A

Hyponatrimia.

36
Q

What electrolyte disturbance causes peaked T waves?

A

Hyperkalemia.

37
Q

What electrolyte disturbance causes tetany?

A

Hypocalcemia.

38
Q

What electrolyte disturbance causes arrhythmias?

A

Hyperkalemia. Hypokalemia. Hypomagnesium.

39
Q

What electrolyte disturbance causes decreased deep tendon reflexes?

A

Hypermagenesia (Drip magnesium is used to fight uterine contractions in partum).

40
Q

What electrolyte disturbance causes flattened T waves and U waves on EKG?

A

Hypokalemia.

41
Q

What are diagnostic features of diabetes insipidus?

A

Polyuria. Dilute urine: low specific gravity, and low urine osmolarity. In water deprivation test, the urine osmolarity does not rise.

42
Q

RFF: Treatment for central DI.

A

Desmopressin.

43
Q

RFF: Treatment for nephrogenic DI.

A

HCTZ, Indomethacin, Amiloride.

44
Q

RFF: Treatment for lithium-induced nephrogenic DI.

A

Amiloride.

45
Q

What are the causes of Hypernatremia?

A

[The 6Ds] Diuretics. Dehydration. Diabetes insipidus. Docs (iatrogenic). Diarrhea. Diseas of the kidney.

DIT Nephrology (9 decks)

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